Provider Demographics
NPI:1205131737
Name:FERVIDA, HEATH HERBERT (PSYD, HSPP, MDIV)
Entity type:Individual
Prefix:DR
First Name:HEATH
Middle Name:HERBERT
Last Name:FERVIDA
Suffix:
Gender:M
Credentials:PSYD, HSPP, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59466 COUNTY ROAD 113
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46517-3644
Mailing Address - Country:US
Mailing Address - Phone:574-830-5778
Mailing Address - Fax:574-830-5157
Practice Address - Street 1:59466 COUNTY ROAD 113
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46517-3644
Practice Address - Country:US
Practice Address - Phone:574-830-5778
Practice Address - Fax:574-830-5157
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042483A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical